Mental disorders and drug and alcohol use can often go hand and hand. Shannon Brogdon, MS, Program Manager, Dual Diagnosis Unit, UPMC Western Psychiatric Hospital explains how treatment is changing and how patients are finding new hope.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– It’s called a dual diagnosis. Mental problems and drug and alcohol abuse often go hand in hand. So how can it best be treated, and is there hope for patients? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast, and joining us right now is Shannon Brogdon. She’s the program manager of the Dual Diagnosis Unit at UPMC Western Psychiatric Hospital. Thank you so much for joining us.

– Thank you so much for having me.

– So, I guess, first, how common is it that folks have a dual diagnosis?

– So that’s kind of a complicated question, but right now the research says that about 50% of individuals who struggle with a severe mental illness also struggle with substance use issues. So about half.

– So are there things about substance use that impact mental disorders? And then what are the things of mental disorders that impact substance abuse?

– So, say somebody has a mental health issue and maybe they’ve had medications that don’t work. Maybe they haven’t found a therapy that works for them. Sometimes, people turn to substances to cope with that depression or anxiety or anything that they’re managing. So that would be the progression of somebody who has a mental health issue and then it turns to substances. People who are using substances often end up having some kind of mood disorder or some kind of mental health issue as a result of their use. So whether that be depression or anxiety as a result of their use, but eventually it all becomes kind of one interconnected issue.

– And so, which comes first? Do we know?

– So, we don’t know, right? So everybody is individual, and every case is complex. So, things like family history of substance use, things like childhood trauma, all of those things can lead to substance use, but also mental illness is something that is hard to cope with, and so some people turn to substance use to cope. So for everybody, what came first is a little bit different. So, those with dual diagnosis definitely have a higher risk of medical issues. Just the physical problems that go along with using, whether that be detoxing or an illness that you contracted through use. So, medical issues are a much bigger problem for people with substance use. As well as accessing services, having the support of family and friends, all of those things are a little bit harder for those with a dual diagnosis.

– Right. And so there’s actually sort of been an evolution as to how folks approach this, and talk a little bit about that because it used to be one or the other, correct?

– Yeah. And sometimes it still is. I would say the research started to catch up and really show that treating dual diagnoses together was the best evidence-based practice in the late ’80s. But I don’t think that that really translated to community services until maybe the late ’90s, early 2000s. And that’s when we started to see things like addiction treatment centers turning into dual diagnosis centers. But there are still places that treat mental health issues and if somebody discloses they have a substance disorder, they’ll refer them out. And so that’s still something that’s prevalent, and not a lot of providers are comfortable treating both still.

– And so, from your perspective, what are the advantages, and why do you think that’s the route to go?

– So, well, first, evidence and research says that that’s the route to go — that treating these things separately is almost a moot point because they’re so interconnected. And so treating your depression without addressing the thing you’re using to cope with your depression probably isn’t going to be very effective. Additionally, people with dual diagnosis have really specific social work needs, really specific medical needs, and being able to focus on the entire patient with a whole team of medical, psychiatric, social work, looking at the person as a whole, there’s just better outcomes that way.

– Right. Right. How does it work if, often, if you treat mental health with medications, but there’s also someone with a dual diagnosis where you would think, we want to get them off of all substances. So, talk about the complexities of that.

– It’s very complex. And for a long time, people with substance use disorder were told some of these psychiatric medications, they shouldn’t be taking because they interacted with substances. Now, we know, from a harm reduction approach, that it’s more important for somebody to take their medications for schizophrenia even if they are still using or drinking. Those side effects that may come up with that combination, it’s risk versus reward, and their mental illness being treated is just more important. Obviously, there are rules, right? There are some things you can’t mix, but it used to be a true and fast rule — if you’re drinking, you don’t take psychiatric medications. And that’s really started to be debunked by research as of late in the last 10 years.

– And would you say you believe researchers might have been surprised when this evidence started to come back?

– Yeah. So evidence does show that harm reduction works. And so harm reduction is, even if people aren’t ready to completely stop their use, we support them in trying to decrease their use or be safer. And so that helps break the stigma a little bit for people who might not want to quit drinking or quit using and that’s a really scary thought, we meet them where they are. So to me, that’s the next phase of evidence-based treatment. So if you support somebody in a safe reduction of use, there’s a bigger chance that they’ll follow up with treatment later to then stop using. And so it sounds crazy, but there are places in Pittsburgh, like Prevention Point Pittsburgh, they have four trucks throughout the city, and they hand out safe using supplies for people. They also hand out Narcan, which is something you can use if somebody overdoses. So, their goal is to reduce overdoses, not necessarily use. And so, as silly as it sounds, the longer somebody is alive, the more likely they are to get treatment eventually, right? You have to be alive to have treatment. And so, for us, that’s what that’s about, is just giving us more time with that person to maybe help them move forward one day.

– Are there certain mental disorders that perhaps make it more prevalent to be a dual diagnosis?

– I wouldn’t say so. I wouldn’t say that there’s any one disorder that we see the most. I would say that those who have, like, a psychotic disorder, schizophrenia or a delusional disorder, the substance use goes a lot hand in hand because that’s how they cope. So, substances can lower voices so they can’t hear them; they dull them. So it’s just a way for them to cope. And it’s highly prevalent for people with psychotic disorders to use substances to cope. But on the flip side of that, long-term substance use can cause very severe depression and anxiety. So there’s really no discrimination as far as mental health issues.

– So someone watching this or listening to this, if you feel like you know someone who is in need of help, or maybe someone feels like they themselves are in need of help, there’s always such a stigma associated with mental health. Talk a little bit about that and what you want people to know about why they shouldn’t be afraid to ask for help.

– Yeah. So the stigma for, I think, mental health is definitely there, but I think it’s almost easier right now for people to accept having a mental health disorder rather than a substance use disorder. I don’t know that people know how common it is to be dealing with both. So for those people, I would say the first step is just to reach out and talk to somebody. And we have a lot of resources that people can do that. And it might sound scary at first, but the whole approach to dual diagnosis is not the old-school way of abstinence only works. We’re a very harm reduction approach. We meet people where they are, and there are so many different levels of care that if you’re experiencing a substance use disorder, it doesn’t mean you have to go away to rehab or go away to the hospital. It could just mean being connected with the right therapist and the right doctor to help you start to decrease and then maybe start to stop using.

– So, what are the ways people can get help?

– So, the first thing I would always tell people is to call resolve. So, resolve is a line that you can call at any time for anything, whether you just want to talk, whether you just have a question about services, or whether you’re in a crisis. You can also call for somebody else. So if you’re worried about somebody else, resolve can send a mobile team out to check on that person. So they are very well-versed clinicians. And they’re 24/7 to answer the phone for you. And that number is 1-888-796-8226. And it’s also spelled out 1-888-7-YOU-CAN.

– So someone watching this, I think I might need help or so-and-so needs help, but I’m afraid if I call, they’re going to show up at my house.

– Right. So if you call and you say, “Hey, I think I might need help, but I’m not sure, but I definitely don’t want anyone to come to my house,” they’ll listen to you. So, communication — just communicate what you’re feeling, communicate what you need. Resolve, they’re very experienced. Unless they feel like your life or somebody else’s life is in danger, they’re not going to come to your house unless you ask them to. So they can just be somebody to even talk to just in the middle of the night if you are feeling lonely. And they’re also somebody you can call if you want to find a therapist quicker. I need a referral to a therapist, what are some numbers I can call tomorrow when I wake up? So, there’s a lot of different reasons.

– Where are other places people can go to get help?

– So the Psychiatric Emergency Room at Western Psych is a place that you can walk in at any time, whether that be you’re in a mental health crisis, whether you feel like you need detox from substance use, you can walk in at any time. You can also call Western Psych to talk about different referrals for service. So you talk about the things you’re looking for, and they can refer you out to the appropriate services within the UPMC service line. And that number is 412-624-1000.

– And when you talk about a mental health crisis, describe for people what that is. When do you know it is time to get help?

– So, you know that you want to be seen by a professional when you are having thoughts to end your own life, you’re having thoughts to harm somebody else, or you don’t feel like you can take care of yourself anymore. Those are things like getting up and eating, taking a shower, cooking for yourself, those kind of things. So those are the three big criteria to, you probably need seen and maybe treatment in a mental health facility. For everybody else who’s just dealing with these everyday kind of scary, “Am I depressed? Am I anxious? Am I drinking too much?” Those kinds of issues can also all be addressed at places like resolve and Western Psych.

– And so, as you look in your program, in the dual diagnosis unit, how many people would you say are in there right now? How common is this?

– So, on our unit, at any time, we have 26 patients, but there are also dual diagnosis patients all throughout the hospital on different floors as well. So, if somebody also has a psychotic disorder but with a mental health or with a substance use issue, maybe they’ll go to the psychotic disorders floor. Maybe that’s just more prevalent. So it’s incredibly common. We typically have 26 patients at a time. And our average length of stay is not very long: three to seven days, maybe. So it’s a big turnover. We see 100, 150 people a month. We are a giant interdisciplinary team. We meet every single morning. And when I say we, I mean psychiatrists, nurses, therapists, pharmacists, social workers, physician assistants, anybody that you can imagine that could be involved. People who are managing the insurance. And we talk about every single patient’s case. We talk about the complexities of it. We talk about discharge planning right away. What would be the best place for this person to follow up with? Who are their supports? Who can we get on board? And we meet about them every day and have a complex discussion about them. Their team then meets with them every day, talks about their progress, makes any changes they might need. Their social worker meets with them every day, talks about what are we going to do after? How are we going to help support you after the hospital? And our patients have anywhere from six to 10 groups a day. They can get individual therapy. We have things like art and music group. So we have just a whole array of things in the hospital to help support somebody that’s in a crisis.

– Right. Have you seen an increase because of COVID?

– I would say we’ve seen an increase in severity, for sure, due to COVID. People were isolated for a very long time. Routines were off. And so a lot of people who are in their recovery based on a routine, so going to meetings, seeing their supports, seeing their doctors and therapists, those things were taken away for a long time at the beginning of the pandemic. And so, coping with those things was really hard for a lot of people. And so, we’ve seen a lot of people who were in recovery relapse, and we’ve seen just an increase in severity of things like depression and anxiety.

– So what does success look like in terms of treatment?

– So, success looks like somebody completing a goal that they set out to do, not one that we gave to them. So our whole approach is helping the patient come to the conclusion that they want to come to. And that could be not using forever, or that could be decreasing, or that could be something different altogether. We see success in people decreasing their use. We see success in people utilizing the hospital less. For us, success is somebody leaves and they go to their outpatient therapy appointment. They’re connected to that next level of care. And for us, that means our job was done right. We made them comfortable in treatment enough to then follow up and continue to care about their treatment. But we also see big successes. So there are peer specialists that are in long-term recovery that come and talk to our patients about what recovery looks like. So, success is varied, and we do see a lot of it.

– What would you say you like most about your job?

– I love working with such an interdisciplinary team, but also, the patients are so wonderful because every single patient that comes in, whether they believe that they have a substance use disorder or not, or they want to change or they don’t, their stories are so complex. So nobody ever just is born and says they want to be addicted to heroin. People, their complex stories lead them to where they are now. And so, my favorite part is just kind of diving in with people and seeing how they got to where they are and what they can do after they beat this disease.

– Yeah. And, finally, as we close, what do you want to say to people again about seeking help if they need it?

– What I live by is if you feel like your life has become unmanageable because of substances, or you feel like a loved one’s substance use has made your life unmanageable, it might be time to get help. And I also want to tell people it’s just so much more common than you’d think.

– Well, Shannon Brogdon, we thank you so much for coming in.

– Thank you.

– Spending time with us today. We certainly do appreciate it.

– Yeah. Thank you so much for having me.

– You’re welcome. I’m Tonia Caruso. Thank for joining us. This is UPMC HealthBeat.

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.